| NPI | 1487180451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: AZ AZCG09090) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 372500000X Chore Provider | |
| 372600000X Adult Companion | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-06-06 |